Variation in the use of screening mammography guidelines has been widely reported. It is clear, even considering the most recently available and optimistic utilization data, that there is a wide disparity between these data and the NCI Year 2000 goals for mammography screening rates. Variability has been explained primarily by the physicians' under-referring of certain "special populations" such as minorities and the elderly. This Project will examine whether physicians' characteristics, e.g., specialty, and patients' characteristics, e.g., race, contribute to the effectiveness of patient education in achieving a completed mammography referral. The core study hypotheses are: l) that primary care physicians' decision to refer is influenced by patients' characteristics such as race, language and health insurance status, and 2) that minority, Spanish-speaking and low income women are significantly less likely than other female patients to perceive their physicians as being enthusiastic about mammography during patient educational sessions. This is a prospective cohort study to determine the relationship between primary care physicians' characteristics, their patients' characteristics, and the physician-patient education process regarding screening mammography. Extensive data collection will occur using a sample of primary care physicians stratified by specialty, and a linked cohort sample of their patients, with validation of the medical outcome, a completed mammogram through radiology facility records. These data will allow physician-level and patient-level analyses on the relationships between physicians' characteristics and behavior, patients' characteristics and their perceptions about their physician's behavior, and compliance with screening guidelines. This Project will provide insight into the role of patient education in limiting access to screening mammography among minority and underscreened women. In addition, the Project will add to our understanding of the importance of explicitly accounting for a physician's specialty and other characteristics when developing effective guideline dissemination strategies.